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<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<title>无标题文档</title>
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 <table width="800" border="1" cellpadding="0">
  <tr>
    <td colspan="2" align="center"><p>申诉单</p>
    <p>&nbsp;</p></td>
  </tr>
  <tr>
    <td height="513" colspan="2"><table width="800" border="1" cellpadding="0">
  <tr>
    <td width="100" align="center">申诉人</td>
    <td colspan="2"><table width="683" border="1" cellpadding="0">
      <tr>
        <td width="199"><p>姓名（必须为申诉所涉及号码机主姓名）</p></td>
        <td width="187"><input type="text" name="name"/><font color="#FF0000">*</font></td>
        <td width="95">联系电话</td>
        <td width="182"><input type="text" name="phone"/><font color="#FF0000">*</font></td>
        </tr>
      <tr>
        <td>电子邮件</td>
        <td><input type="text" name="email"/><font color="#FF0000">*</font></td>
        <td><font size="-1">邮件编码</font></td>
        <td><input type="text" name="num"/><font color="#FF0000">*</font></td>
        </tr>
      </table></td>
  </tr>
  <tr>
    <td align="center" rowspan="2">被申诉人</td>
    <td width="87" height="45">企业名称</td>
    <td width="592"><select><option value="1">福州市</option></select>
    <select><option value="1">鼓楼</option></select>
    <select><option value="1">电信</option></select></td>
  </tr>
  <tr>
    <td height="47">通信地址</td>
    <td><input name="address" type="text" style="width:500px;height:25px" /></td>
    <td width="1"></td>
  </tr>
  <tr>
    <td width="200" height="66">是否就申诉事项向被申诉人提出申诉</td>
    <td colspan="2"><input type="radio"/>是
    <input type="radio" />否</td>
  </tr>
  <tr>
    <td width="200" height="71">被申诉人是否给予处理或答复</td>
    <td colspan="2"><input type="radio"/>是
    <input type="radio" />否</td>
  </tr>
  <tr>
    <td height="58" rowspan="3">申诉内容</td>
    <td height="56">申诉要求</td>
    <td><textarea name="request" style="width:500px;height:40px">详见附件用户申诉信</textarea></td>
  </tr>
  <tr>
    <td height="59">申诉事实与理由</td>
    <td><textarea name="request" style="width:500px;height:40px">详见附件用户申诉信</textarea></td>
  </tr>
  <tr>
    <td height="76">申诉依据</td>
    <td><textarea name="request" style="width:500px;height:40px">详见附件用户申诉信</textarea></td>
  </tr>
    </table>
</td>
  </tr>
  <tr>
    <td width="105" height="33">申诉来源</td>
    <td width="691"><select><option value="1">传真</option></select></td>
  </tr>
  <tr>
    <td height="38">附件上传</td>
    <td height="38"><input type="text" name="rest"/> <input type="button" value="浏览.." /><input type="button" value="添加附件" /></td>
  </tr>
  <tr>
    <td height="27" colspan="2"><input type="button" value="提交" style="margin-left:110px;width:80px"/></td>
  </tr>
</table>

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